An occupational therapist trained in Ayres Sensory Integration ® accredited by SAISI would be able to make a diagnosis of a SI dysfunction.
To make a diagnosis of SI dysfunction, there needs to be evidence of a deficit in processing of vestibular,
proprioceptive or tactile sensory inputs. These deficits must not be a result of either peripheral or central nervous system dysfunction.
The use of various standardised and non-standardised assessments, checklists and clinical observations are used in collaboration with collateral information. Currently, “The Sensory Integration and Praxis Test (SIPT)” is the golden standard for testing internationally. As occupational therapists it is important that all information obtained during testing is confirmed with evidence obtained from the child’s functional abilities at home and at school.
Difficulties experienced in Sensory Integration dysfunction may include:
• Clumsy behaviour; child may trip / fall often, bump into things etc…
• Postural control may be poor.
• Sensory defensiveness, i.e. fussy dressers (only cotton, seams turned out), fussy feeders, uneasy on jungle gyms/avoid swings, unsettled in noisy environments (e.g. parties/ shopping malls), etc.
• Sensory dormancy (often resulting in seeking behaviours), i.e. constantly moving, fidgeting, touching, making noises, crashing into things, not hearing when being called (despite normal hearing), incomplete work in class due to “daydreaming”, etc.
• Difficulties co-ordinating the two sides of the body and/or crossing the body midline, as seen when swimming, riding a bicycle, eating with a knife and fork.
• Difficulties planning, sequencing and executing novel (new) movement patterns. Takes longer than average to learn new tasks such as riding a bicycle.
• Speech and language development may be affected.
• Poor self-care.
• Difficulties developing and sustaining relationships and poor social skills.
• Difficulty with focus and attention.
Difficulties in SI dysfunction are classified in two areas:
1. SI dysfunction of modulation
2. SI dysfunction of discrimination
It is important to always keep differential diagnoses in mind, i.e. emotional issues, Attention Deficit /Hyperactivity Disorders, Hemispheric dysfunction, Autistic Spectrum Disorder, Cerebral Palsy, Down’s Syndrome, hearing and visual impairments.
Sensory modulation refers to the ability of the nervous system to regulate, organize and prioritize incoming sensory information, inhibiting or suppressing irrelevant information and prioritizing and helping the child to focus on relevant information.
A child with a well-modulated nervous system adapts effectively to changes in the environment and is able to maintain a level of arousal and attention appropriate to the task at hand. The child is able to block out irrelevant information, attend to relevant information and respond appropriately and adaptively. This enables the child to engage in a meaningful manner in activities of daily life.
E.g. in the classroom environment, a child is able to ignore the background noise of children talking, feet scuffling the floor, bells ringing, enabling him/her to attend to the teacher’s voice to listen to the instructions and execute the task required.
Sensory discrimination is the interpretation of sensory input within the central nervous system to make sense of what is perceived, forming perceptions and allowing for response to sensory input. E.g. hearing a noise (registering), interpreting it is your name being called, resulting in responding by either turning your head towards the stimulus or verbally answering to the call.
Evaluation in SI is an on-going process. Continued discussion with caregivers, teachers etc. is vital.
A combination of the following is used to gather data:
• Interviews with parents, caregivers, teachers etc.
• Sensory history questionnaires, standardized questionnaires, i.e. The Sensory Profile by W. Dunn, The Touch Inventory for Pre-schoolers (TIP), Sensory Processing Measure Home (by Parham and Ecker), Sensory Processing Measure School (by Kuhaneck, Henry and Glennon) as well as non-standardized questionnaires, i.e. checklist for tactile defensive behaviour, sensory motor history.
• Observations in natural settings, i.e. home / school / playground.
• Clinical observations and formal observations during standardized testing.
• Formal assessment / Standardized testing, i.e. The Sensory Integration and Praxis Tests (SIPT), Millers Assessment for Pre-schoolers (MAP), the Test of Sensory Function in Infants (TSFI) and DeGangi-Berk Test of Sensory Integration.
• Continued observation during therapy and continued interaction with parents is of the utmost importance.